1. Gynaecological Cancer Pathway – current state and where to from here? Michael Burling O&G Registrar- Waikato Hospital 25/10/15

2. Brief Overview Ministry of Health Initiative o Introduced in July 2012 o Enhanced quality of care and timeliness of appointments, investigations, and treatment Became nation-wide target for DHBs from October 1 st, 2014 o No longer just an ‘initiative’ Target July 2016 – 85% target June 2017 – 90% target

3. Pathway- NOT THAT SIMPLE

4. Current State 2 Audits on PMB at Waikato Hospital o Aug-Dec 2014 – Michael Burling o Oct-March 2015 - TIs - Sukhi Sandhu & Matthew Wilson Aim o To determine how frequently standard 1 (ie. 62 days from referral  treatment) is being met o To breakdown the individual timeframes from referral  treatment to determine how long each process is taking o 14 days from referral  first specialist assessment -Referral  Triage -Triage  Clinic o Clinic  Hysteroscopy  Histology  MDM  Treatment

5. Summary of Results – Audit 1 USS GP Referral Pathology Hysterosco py FSA Standard 2- 14% Standard 1 – 0% Treatment Standard 3- 50% 11.7 41.1 53. 9 6.5 32

6. Results Standard 1– 0% Standard 2 – 33% (a >50% improvement) Standard 3- 68%

7. Pathway PrimarySecondaryTertiaryPost treatment follow-up Patient education GP education HSCan criteria Appropriate primary investigation Correct referral category Better electronic referral system Urgent USS that can be done as OP within 1 week. Timely and correct triage Aim for FSA to be with in 14days HSCan appointment slots or clinics TV USS use in GOPC Timely hysteroscopy and outpatient hysteroscopy Improve histology turn around Timely staging investigations and MDM review Timely and appropriate referrals to Auckland Gynaeoncology MDM and decisions to be made on where and when the surgery will be Do we need more Gynaeoncologist? Do we need Generalist to do more? Appropriate follow-up and support post- treatment Need good collection

8. Secondary care center pathway Admin Staff O&G specialist FSA +Ix +/- Treatment HSCan Coordinator - GC Nurse Specialist or Doctor RadiologistPathologist Anaesthetist and OT staff Medical and Radiation oncologist Tertiary Services

9. 12 days 14 days 7 days ~51 days Ideal timeline? 2 days

10. WHERE TO FROM HERE? Work together as a group and within our own hospital system to improve our clinical pathways. Share information- No need to re-invent the wheel again and again Having a dedicated Gynae-oncology coordinator in each hospital that is responsible for HSCan referrals and making sure all patient is seen, investigated and treated in a timely manner!! Better data collection to allow better research to improve our services and allow transparency with the MOH/DHB/ourselves/Patients

11. Questions